A Premier Gynecology and Obstetrics Group in Colorado Springs

Patient Forms

For your convenience and in an effort to reduce the amount of time spent in our office completing the necessary paperwork, Academy Women’s Healthcare Associates have made the forms available for download or you may fill them out online.


arrowpATIENT Health questionNaire

This health form is to be completed in order to obtain information regarding the patient's health history.

Please use our Patient Portal to securely fill out the form online or print a copy of this form and complete it prior to coming for your first office visit.

Download_buttononline_form_button


arrowPATIENT REGISTRATION FORM

This registration form is to be completed every year in order to process insurance claims correctly and to have updated information on file at AWHA.

Please use our Patient Portal to securely fill out the form online or print a copy of this form and complete it prior to coming for your office visit. Online forms must be submitted 48 hours prior to your appoinment in order to give our staff time to process your paperwork.

Download_buttononline_form_button


arrowRECORDS RELEASE FORM

This form authorizes the release of health information to a third party.

When requesting release of your health records to a third party, please print a copy of this form. After completing it, fax (719.622.3400) or drop the form off at our office, attention: Andre Beach.

Download_button


arrowINFORMATION AUTHORIZATION RELEASE CONSENT FORM

This form will allow us to release information about you, the patient, to individual(s) who are non-medical in relation. This consent form can be changed by the patient at anytime for any reason. Please use our Patient Portal to securely fill out the form online or print a copy of this form and complete it prior to your visit.

Download_buttononline_form_button


arrowRIGHT TO PRIVACY NOTICE

This form provides notice to all practice patients of their right to privacy of their protected health information (PHI). This policy describes procedures implemented by the practice to ensure the privacy of PHI.

Download_button

patient portal

Mobile Version